BTS Best Practice Conference Awards

We've heard from recipients of the BTS Best Practice Conference Awards about what they learnt at the Winter Meeting 2016 and the ECFS Conference 2017, how they shared their experience with their teams, and how such learnings could affect patient care.

European Cystic Fibrosis Society Conference 2017

Abigail Cowley PhD Student Manchester

Receiving the ECFC travel grant has been extremely helpful in facilitating my PhD studies, which focus on the interplay between Aspergillus fumigatus and the mucus barrier in cystic fibrosis. Being based in a university laboratory it is always useful to attend clinical meetings, seminars and conferences to gain feedback and ideas to help drive the clinical side of my project. Being able to attend a predominantly clinical conference allowed me to seek clinical relevance of the work I am doing, whilst sharing in vitro observations with various clinicians. I learnt a lot about different research methods being used to study aspergillosis and other pulmonary infections in cystic fibrosis, and this has allowed me to develop new ideas of how I can move forward with my research. I was also pleased to receive the award for Best Poster in the Microbiology/Antibiotics category.

Following the conference I have been able to feed back the information I have learnt to other members of my laboratory, which may in turn help to further other research being carried out in our faculty. By learning more about the clinical research of others in the CF community I hope to improve the quality of my own research, which may ultimately aid the development of novel therapeutic agents in order to improve patient health.

Richard Morton ST5 Royal Brompton Hospital

A generous grant from the British Thoracic Society ensured I was able to attend the 2017 ECFS conference in Seville this year. Poster in hand, I took on the stifling heat and headed to the impressive FIBES exhibition centre for 3 days of fascinating talks. The pavements were littered with bright yellow petals, decorating the whole city in ECFS colours for the occasion.

It all kicked off with a whistle-stop tour of past ECFS conferences. It was interesting to see how many of the conferences have taken place against a backdrop of historical European events. Fortunately, there were no signs of Brexit influencing the proceedings yet, as 485 UK delegates made the journey to Spain, more than any other country. After two cutting-edge talks on intestinal organoids and CRISPR technology, and an unexpected bout of flamenco, the meeting was declared open.

I learned about using MRI and LCI to track early disease in CF. I heard a lot about these remarkable organoids which promise to facilitate personalised medicine for CF patients. Dr Retsch-Bogart, full of enthusiasm, explained how new modulator therapies and their combinations would become available in the coming years. Prof Mahenthiralingam updated us on some novel, multimodal agents with bactericidal, mucolytic or antibiotic-potentiating properties, some of which are already in phase 2 trials. The microbiology of CF was a frequent topic of conversation, with exciting studies underway which will hopefully answer some longstanding questions about the treatment of exacerbations and the value of treating chronic Staph in children. A memorable debate pitted four CF heavyweights against each other in trying to convince the audience of the right time to start modulator therapy.

Over 2,000 delegates attended this conference but it was clear that this is a relatively small and accordingly tight-knit community of scientists, doctors, physiotherapists and nurses. They clearly enjoyed the opportunity to catch up with the colleagues they have been working with for a long time, decades in some cases. The mood was festive and welcoming to newcomers such as myself.

For my part, it was a wonderful learning opportunity and it also allowed me to present some of the work I had carried out in the CF department I had been working in. The dynamism and energy of the CF community was clear to see and the breadth of research being presented made it clear that the future is bright for patients with CF. I look forward to being a part of it.

Dr Charlotte Addy Clinical Research Fellow at Belfast City Hospital

Thanks to a BTS Travel grant I was able to travel to Seville to attend the ECFS2017 – bringing together sunshine with sputum! This conference is one of the most important in the CF calendar bringing together CF teams and researchers from all over the world. Over 4 days I was able to learn about topics as diverse as emerging pathogens in CF, the publication process of top journals, to emerging technologies in diagnostics and monitoring. As a respiratory physician embarking on a career in CF this was a fantastic opportunity to build on my knowledge, build networks with other CF teams and generate ideas for future ways to deliver CF care.

I was able to present my own work on adherence to inhaled antibiotics within a new session format – the interactive poster discussion – a great addition to the conference which generated lively debate and genuine enthusiasm for supporting and empowering people with CF to be actively involved in optimising and balancing their own treatments. The ideas generated in this session will assist me in taking this work forward and using it to improve care within our centre.

A key theme through the conference was the impact of CFTR modulator therapy on current and future care. Both the impact these have on increased stability, options for reducing treatment burden in this scenario and the optimal time to initiate treatment. It was also exciting to see the future drug pipeline and future options for CFTR modulation undergoing trials now and in the future.

The results of other trials demonstrated the drive to enhance delivery of CF care in the 21st Century including future anti-inflammatories, use of novel microbiological techniques to tailor antibiotic treatment and new agents to aid sputum clearance.

Bugs are always at the centre of any CF conference with excellent sessions on bacteria, fungi and infection control being highlights of the conference for me. Both new research, learning from other teams approaches and future treatments mean this area will continue to be evolve in coming years. In particular a focus on the rise of newer pathogens and how to both assess their impact and prevent spread of these organisms will play an increasing role in the future.

Overall this experience served to only further my own enthusiasm for optimising delivery of CF care and makes me look forward to a career in CF. I will be back next year! Hopefully, future recipients will benefit equally and be enthused to join the world of sputumology!

Freddy Frost, CF Fellow at Liverpool Heart and Chest Hospital

The 40th ECFS conference took place in Seville and I was lucky enough to be awarded a BTS travel fellowship to attend. The conference started on Wednesday 7th June with an opening plenary. On Thursday the conference proper commenced and I attended a session on novel microbiology techniques and how to implement them in clinical practice. Next generation sequencing has allowed techniques such as 16S microbiome analysis and whole genome sequencing to be routinely implemented in research but this session provided useful examples of how to implement them clinically. My learning points here are that these techniques offer the potential for precision individualised approaches to antibiotic prescription which will benefit patients as well as improve antibiotic stewardship, the technology may not quite yet be where it needs to be for full scale clinical use in the NHS but we need to forge close relationships with between respiratory and microbiology departments to realise the full potential. This session was followed up by news from the CF-Matters study, a study of the use of microbiome analysis to inform treatment of respiratory infections in CF, the study is now completed and results are eagerly awaited.

In the afternoon at the “below the diaphragm” session there was an interesting talk on the outcomes of pregnancy in CF. This highlighted the importance of planning pregnancies and also set out a framework for close co-operation with the obstetricians in-order to optimise patients’ health in the run-up to giving birth. Next, a workshop considering the relationship between gut and airway microbiome generated interest and debate but evidence that the gut microbiota may have roles in pulmonary exacerbation raises the prospect of earlier detection of exacerbations and also of probiotic prophylaxis which could be of huge benefit to patients it terms of lung function deterioration and quality of life if fulfilled. At the “Bringing CF care into the 21st century” session there were presentations on a variety of tele-care and homecare systems. Remote monitoring appears to work well in certain patients and strategies for telemedicine consultations as well as virtual wards for patients receiving home IV antibiotics are both ideas that I will bring back to the MDT in Liverpool for discussion and potential implementation. Attending the conference has allowed me to gain a better understanding of some of the new technologies available not only in microbiology/infection but also for remote/distance management of stable patients. Both technologies aim to streamline and personalise patients’ treatment and have the potential to transform local services as well as patient experience and I will form closer links with our local microbiology team and provide input into our telemedicine pilot study as a result of attending this conference.

BTS Winter Meeting 2016

James Reihill, School of Pharmacy, Queens University Belfast

The BTS Learning and Best Practice Travel Grant enabled me to attend the 2016 BTS Winter Meeting which was an excellent opportunity to also learn about common respiratory diseases outside of my current research area (CF). I was intrigued by several talks relating to COPD research including new insights in to the pathophysiological role of neutrophils and airway proteases which I am keen to investigate further. I have subsequently disseminated details of work presented at BTS2016, including presentations delivered by Dr’s Sapey and Wedzicha, to our research team which were received with great interest. I am very grateful for the award of this scholarship as this was a highly beneficial meeting that I may not have been able to attend otherwise.

Many thanks once again for the BTS Learning and Best Practice grant which enabled me to attend the Winter BTS Meeting on the 7th of December.

As a medical student, learning the basic information from the many textbooks can already seem like a challenge and huge achievement. It can be easy to lose sight of the cutting edge research taking place across the globe to build on that textbook knowledge. The Winter BTS Meeting opened my eyes to the revolutionary developments being made in investigating and treating respiratory conditions. The most notable symposium for me was on management of the difficult asthma patient. I learnt about two new advances, Omalizumab and Bronchial Thermoplasty that can be used in certain patients with severe asthma. Omalizumab is a monoclonal antibody that acts against IgE, which is the main antibody responsible for allergic asthma exacerbations. Bronchial Thermoplasty reduces smooth muscle thickness in the airways, opening them up and preventing excess bronchoconstriction in response to an allergen. This is a great step towards care of patients who have repeated severe asthma attacks needing hospitalization.

I also learnt about new technologies like inhalers with acoustic sensors that can monitor patients' inhaler techniques. Simple measures like inhaler techniques can go a long way in bettering a patient's self-management of their asthma. A recurrent theme that resonated throughout the Winter meeting, and was further reinforced by BTS's new president Professor Edwin Chilvers, was that we are all in this for patients. We need to go beyond our roles as clinicians and think of ways to improve our patients' management through research.

I would like to thank GSK and Vertex for giving me this opportunity and sparking an interest in research and respiratory medicine for me.

Dr Ernie Wong, Imperial College

I was fortunate enough to be awarded with a BTS Learning and Best Practice Grant to attend the 2016 BTS Winter Meeting. My academic/ research interests include severe asthma and virus-induced asthma exacerbations. With respect to severe asthma, I found the symposium “Asthma – from research to clinical reality” especially educational. In particular, the presentation by Dr. James Hull on the role of the upper airway in severe asthma was very informative and relevant to my clinical practice as it is important to evaluate the entire respiratory tract when assessing patients with known or suspected severe treatment refractory asthma. Upper airway pathology often mimic and indeed co-exist with genuine asthma and is extremely challenging to decipher in the clinical setting. The assessment of potential vocal cord dysfunction and large airway malacia is an area that needs further developing in asthma centres in the UK. The use of nasoendoscopy and CT in both resting and ‘stress’ states have enabled physicians to visualise and assess the potential presence of upper airway pathology such as vocal cord dysfunction. Novel treatment also includes botox injection to the larynx though this is still very much in the development phase.

Since the meeting, I have reflected on my own clinical practice and highlighted the importance of assessing for upper airway pathology in asthma with my consultants at our departmental meeting. We have since encountered two new patients with severe asthma, both of whom had suspected upper airway pathology. With this new learning in place, we performed nasoendoscopy (with the assistance of our ENT colleagues) and identified tracheal malacia secondary to a massive thyroid goiter in one case and vocal cord palsy in the other! I’m very pleased that my attendance at the BTS meeting has enabled me to impact my patient care in a positive and meaningful fashion.

I also attended the BTS specialist advisory group meeting on asthma. This gave me the insight into the current outlook and needs with respect to asthma in the UK and is helpful for me as I plan my own career in severe asthma. Finally, the fellowship gave me the invaluable opportunity to meet and network with other colleagues who share the same academic interests. I would highly recommend the travel fellowship to my colleagues.

Dr Daniel Burrage, Specialist Trainee in Pharmacology and Therapeutics and General Medicine, St George’s London

The BTS Winter Meeting was a great opportunity for me to focus on research addressing patient experiences in COPD. Having recently gone set up a new research study myself with the input of patients with COPD I was interested to hear how patient experiences were being used in the wider research community.

A particularly interesting poster discussion evaluated the individual activity descriptors of the MRC dyspnoea scale. This commonly used scale used to grade COPD severity based on the impact of breathlessness on activity highlighted some of the weakness of having multiple descriptive components within each grade. It identified that separating “leave the house” and “dressing/undressing” components for grade 5 may prove more informative.

Another interesting poster discussion addressed the relationship between COPD exacerbations and anxiety and depression in patients, carers and patient-carer dyads. This brilliant study highlighted to me the high burden of psychological morbidity not only in patients, but also their carers; and how anxiety and depression can affect this relationship.

At the winter meeting itself our team had debriefed in between sessions, sharing interesting sessions we had attended. In addition we discussed these areas of interest more widely in our research lab meeting.

For me the first take away message is to be mindful of how I use MRC dyspnoea scale when conducting my own research in COPD. In particular to recognise some of its weaknesses and to consider using a more expanded version to better capture the functional impact of COPD on patient activity.

Secondly, I now recognise the importance of being alert to the potential impact of psychological morbidity on patients with COPD and their carers. Whilst more research is needed in this area to look at how interventions could be used, making attempts to recognise with patients and carers that anxiety and depression is common seems a logical first step.

Kate Reed, Medical Student, Kings College London

I had a brilliant time at the 2016 BTS Winter Meeting where I learnt about new approaches to treating chronic lung disease, tissue regeneration and the concept of precision medicine and how it differs from conventional therapeutic approaches. In terms of what I have shared with my colleagues, I was particularly keen to share the new DVLA guidelines for assessing fitness to drive in patients with obstructive sleep apnoea. Only 70% of sleep physicians have been found to be aware of the changes, and therefore I wanted to ensure that my colleagues were up to date. These new guidelines have been found to be difficult to follow for the majority of sleep professionals and may prevent patients coming forward to discuss their fitness to drive. We discussed the importance of good communication with our patients in regards to the DVLA and adhering to the regulations. Thank you very much for the support it was a fantastic experience.

Amila Rathpanala, Clinical Fellow in ILD, Oxford

The travel grant gave an excellent opportunity to update my knowledge especially in the field of interstitial lung disease. I learnt to identify different radiological patterns of sarcoidosis and to predict their prognosis based in above patterns. Furthermore it facilitated me to change my attitudes towards treatment options in idiopathic pulmonary fibrosis (IPF). As a resulted it aided me to discuss risks and benefits of these novel treatments in a broader way with patients.

I was extremely lucky to present three research abstracts during this exceptional meeting. I got excellent feedback for those studies from the world experts on this field, which allowed me thinking in newer dimensions.

All of those studies on real life experiences using novel treatments in IPF, have permitted counselling by both medical and nursing staff to be grounded in the actual patient experience of antifibrotic therapy. An improved knowledge on side effects has allowed the nursing staff to give tailored counselling based on patient experience rather than trail data. The data on lung function decline has provided local medical staff with additional information to support patients in making an informed decision regarding starting antifibrotic therapy and potentially deciding between the two current alternatives. Standard operating procedures (SOP) have been developed for both Pirfenidone and Nintedanib, which have been informed by each of these studies as well as data collected on service helpline usage. The SOPs have allowed the nursing staff to operate with greater autonomy in supporting patients with dosage changes, allowing medical staff to focus their efforts on those patients where there are additional concerns.

In summary, the BTS Winter Meeting was extremely useful for me on many ways. It aided in development our understanding in certain diseases and practices. In addition, it gave me a platform to present my research studies. Ultimately the excellent feedback I received from the world experts, have encouraged me to commit more of time for newer research projects. Finally, it facilitated us to assess our current practices and modify it for betterment of patient care.

Nicola Maddock, Macmillan lung cancer CNS, Liverpool

This was my first visit to the conference and I found it to be a welcoming, informative, collaborative meeting. Attendees took a great interest in our poster and presentation and it was invigorating to see how many people were dedicated to improving/sharing their practice.

I found the display of posters and the corresponding numbers on the timetable useful as I could easily identify what was relevant to my practice, but not only that, I could identify things that were outside of my practice but influence my patient population.

Previous conferences I have attended have been predominantly associated to Lung cancer. I found that this conference helped to expand my knowledge on Lung disease as a whole. In my role, assessments are paramount and being able to identify diseases that impact on patients overall health status facilitates a better assessment.

The session on Lung cancer pathways was particularly relevant and stirred up some excellent debates, which in turn, makes you revisit your own practice/pathways.

Perhaps the most valuable aspect of the day was experiencing the camaradery of my team. It is not often you get together as a wider team to share your practices with colleagues/peers and this support is invaluable. So much so, that we are looking at how we could facilitate more members of our team to go to this conference in the future.

I feel educationally this conference has given me some food for thought and I will certainly be exploring more avenues to enhance my practice. It has also helped with team dynamics and the relationships which we can build on. With such strong, dedicated team work this can only have benefit for patients as we are constantly looking at ways to improve patient pathways. It is excellent that we have platforms to enable us to share and critique our work. I would certainly be looking at attending this conference again.

Helen Ashcroft, Physiotherapist, Aintree NHS Hospital Trust

I was very grateful to receive the Best Practice award at the BTS Winter Meeting in 2016. For me, this was the most important conference presentation I have given to date. For the last two and a half years I have been working with a small research team exploring telemonitoring in Motor Neurone Disease and it’s potential for Non-Invasively Ventilated patients. Previously, we had the opportunity to present posters regarding our progress, but this year I had the privilege of being able to address my peers through spoken presentation. This was hosted by respected medics from the field of ventilation and was well attended by many professionals working within the field. Since my work was qualitative, I had the opportunity to express to a highly relevant group of professionals the opinion of the patients who were taking part in the research. I found this was a great opportunity to answer questions from the group and to discuss / propose the way forward for this innovative method of care. Within the group there were also highly relevant clinicians that I was able to meet and talk with after the presentation, with whom I would not usually cross paths. This included a consultant from a London hospital who was developing a tool that could be integrated in to my own research in future and would, in fact, be a very beneficial addition. Quite an exciting discovery! I hope that the networking opportunity has engaged other clinicians who may be willing to take forward this method of care in a much larger trial that could improve patient quality of life and change routine follow up for the better in this patient group, if the outcomes continue to be positive.

Within the presentation group there were also other centres working with similar patient groups to my own. One of these described experiences of remotely monitoring patients using non-invasive ventilation which demonstrated that compliance had been increased through remote monitoring and initially objective parameters had improved, however these declined at 6 months which suggests that a 6 month follow up period may be beneficial. I will bear this in mind when considering future service delivery and design. I also enjoyed hearing of another centres experiences of using auto-titrating NIV devices that could create efficiencies for NIV services. This is all beneficial information when it comes to service redesign, which is a continual part of the Clinical Specialist Physiotherapist role that I work in. I hope that this information will help to shape and improve the quality of service that we provide for patients in future.

It was fortunate that the conference programme included many aspects of NIV, CPAP and sleep research and teaching which were beneficial to my personal learning. I have been able to draw the attention of my colleagues to these pieces also. Particularly helpful was the increased awareness I gained of research that is being undertaken in other centres which is relevant to our work as a team and could be interesting to participate in, or just to be conscious of when making decisions locally.

Discussion around the new guidelines for diagnosing and monitoring asthma. A number of presenters discussed the relative merits and demerits of the diagnostic tests suggested in this guideline, and the discussion and questions around these presentations gave some insight into the thought process which had gone into writing the guidelines. I have made a point of fully reading and considering the guidelines since returning from BTS and will be much more aware of them in my day-to-day patient care now.

Several posters were presented regarding Tiotropium in children – I am aware that this drug is widely used in adults, but it is not currently licensed in the paediatric population. Having read in detail about its safety and efficacy in children I will be watching with interest to see whether this drug is approved for use in a paediatric population in the UK, and if it is I will feel much more confident about using it in my practice in future.

Two fantastic symposium presentations on personalised medicine in cystic fibrosis and CFTR modulation – this is an area I am particularly interested in personally, and two inspirational speakers summarising the current state of progress in this field left me feeling even more inspired to continue to be involved in CF research in future if I can. I think listening to experts in a field in which one is interested, and leaving feeling inspired, is one of the main reasons to attend a big conference like this as a trainee.

A session on the 100, 000 genomes project, and how it will improve the care of patients with rare diseases such as PCD in future. We see a relatively large number of children with PCD in Manchester, where I am based, and so this felt particularly relevant for me.

All of the above, plus a couple of other individual posters I thought were particularly interesting, were presented to my colleagues in the respiratory department at Royal Manchester Children’s Hospital when I returned as part of our breakfast teaching programme. I volunteered to do this talk after being awarded this fellowship, so that I could evidence shared my knowledge with my colleagues. I have now had the opportunity to give “feedback” talks following attendance at several national and international conferences, and on every occasion I have found that thinking about what I will share with colleagues has focused my mind and enhanced my own learning from the meeting. I would strongly recommend trainees attending conferences to do this themselves.

James Thompson, PhD Student, Hull York Medical School, University of Hull

I was extremely grateful to receive a British Thoracic Society Best Practice Award to attend the BTS Winter Meeting in December 2016. This was my first respiratory-related national conference that allowed me to meet many other scientists and medical professionals whose work I have been following closely via journal publications and presentations.

I learnt a great deal at this conference, within my own research areas of idiopathic pulmonary fibrosis and imaging, as well as in other areas such as chronic cough, COPD, sarcoidosis and asthma. Being a scientist, it can often be easy to lose track of the bigger picture of translating our research into patient care. Due to the large clinical professional attendance at the meeting, I was able to listen to leading medical professionals about where there are unmet clinical needs, provoking thoughts about new potential projects.

Throughout the meeting I managed to speak with multiple people within my own area, discussing ideas and ongoing projects, which was incredibly useful. This gave me fresh and original ideas to take back to my institution and present to my supervisors/colleagues to help direct the next steps of the project. Not only did was I able to present these ideas to my colleagues, I was able to suggest collaborations with medical professionals/scientists that I had met at the meeting.

This conference has made me think about my own research and, specifically, how it may translate into patient care in the clinic. Through talking to medical professionals at the conference I have learnt that while carrying out research, to always try and think how this could be translated further down the line, rather than doing research for the sake of research. After all, the point of research is to benefit people.

BTS is grateful to GSK and Vertex Pharmaceuticals for providing funds to support this initiative. The companies are not involved in any way in setting the criteria for selection or the selection process itself.